Cardiac rhythm disturbance are the result of altered in impulse generation (automaticity), altered impulse propagation, or both factors acting together. The physiological regulation of automaticity and conduction is derailed. The factors which precipitate arrhythmias include myocardial ischemia with hypoxia and pH and electrolyte abnormalities excessive stretch excessive discharge of endogenous catecholamine’s. Excessive sensitivity to autonomic regulators and excessive exposure to drugs like digitalis and other potentially cardio toxic substance.